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WORKERS COMPENSATION <br />AND <br />EMPLOYERS LIABILITY POLICY <br />ENDORSEMENT WC 99 03 76 (A) <br />POLICY NUMBER: <br />WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS <br />ENDORSEMENT CALIFORNIA <br />(BLANKET WAIVER) <br />We have the right to recover our payments from anyone liable for an injury covered by this policy.We will not <br />enforce our right against the person or organization named in the Schedule. <br />The additional premium for this endorsement shall be %of the California workers'compensation pre- <br />mium. <br />Schedule <br />Person or Organization Job Description <br />This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise <br />stated. <br />(The information below is required only when this endorsement is issued subsequent to preparation of <br />the policy.) <br />Insurance Company Countersigned by <br />DATE OF ISSUE:Page 1 of 1 <br />Any Person or organization for which the insured has agreed by written contract executed prior to <br />loss to furnish this waiver. <br />UB2K987427 <br />Travelers Property Casualty Company of America <br />4/3/2024 <br />DocuSign Envelope ID: 27E79A54-51B9-4F19-98C5-1BA1910A416B